Non small cell lung cancer medical therapy stage II: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
{{Non small cell lung cancer}} | {{Non small cell lung cancer}} | ||
{{CMG}}; {{AE}} {{Alonso}}{{MV}} | |||
{{CMG}}; {{AE}} {{Alonso}} | |||
==Overview== | ==Overview== | ||
Therapies for non-small cell lung cancer stage II include [[surgery]], [[neoadjuvant chemotherapy]], [[adjuvant chemotherapy]], and [[radiation therapy]]. If the [[tumor]] is resectable, the preferred treatment for stage II non small cell lung cancer, includes: surgical resection with [[lymph node]] dissection and pathological evaluation. If evidence of [[lymph node]] extension of the disease is present adjutant [[Non small cell lung cancer chemotherapy|chemotherapy]] should be administered. | |||
==Medical Therapy for Stage II Non-Small Cell Lung Cancer== | ==Medical Therapy for Stage II Non-Small Cell Lung Cancer== | ||
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{{familytree | E01 | | E02 | | | E01=Yes|E02=No}} | {{familytree | E01 | | E02 | | | E01=Yes|E02=No}} | ||
{{familytree | |!| | | |!| | | | |}} | {{familytree | |!| | | |!| | | | |}} | ||
{{familytree | F01 | | F02 | | | F01=[[Non small cell | {{familytree | F01 | | F02 | | | F01=[[Non small cell lung cancer medical therapy stage III|Click here for the stage III treatment]]|F02=Is the [[tumor]] operable?}} | ||
{{familytree | | | | | {{familytree | | |,|-|-|^|-|-|.| | |}} | ||
{{familytree | | | | {{familytree | | G01 | | | | G02 | | G01=Yes|G02=No}} | ||
{{familytree | | | | | {{familytree | | |!| | | | | |!| | | |}} | ||
{{familytree | | | | {{familytree | | H01 | | | | H02 | | | | H01=Surgical resection + [[lymph node]] dissection|H02=Does the patient presents metastasis to ipsilateral [[Tracheobroncuial lymph nodes|peribronchial]] and/or [[Tracheobroncuial lymph nodes|hiliar nodes]] and intrapulmonar nodes (N1)?}} | ||
{{familytree | | | | | |,|-|^|-|.| | | |}} | {{familytree | | |!| | | |,|-|^|-|.| | | |}} | ||
{{familytree | | | {{familytree | | I03 | | I01 | | I02 | | | | | I01=Yes|I02=No|I03=If lymph node extension is detected initiate neoadjuvant[[Non small cell lung cancer chemotherapy#Chemotherapy plus radiation therapy|chemotherapy + radiation therapy]]}} | ||
{{familytree | | | | | |!| | | |!| | |}} | {{familytree | | | | | | |!| | | |!| | |}} | ||
{{familytree | | | | | J01 | | J02 | | J01=[[Non small cell | {{familytree | | | | | | J01 | | J02 | | J01=[[Non small cell lung cancer chemotherapy#Chemotherapy plus Radiation Therapy|chemotherapy + radiation therapy]]|J02=[[Non small cell lung cancer medical therapy radiation therapy|radiation therapy with stereotactic ablative radiotherapy]]<br>Adjuvant [[Non small cell lung cancer chemotherapy|Chemotherapy]] should be added for high-risk stages}} | ||
{{familytree/end}} | {{familytree/end}} | ||
<br> | <br> | ||
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===Stage IIB=== | ===Stage IIB=== | ||
Shown below is the algorithm on the treatment of the stage IIB non-small cell lung cancer based on the 2014 NCCN Non-Small Cell Lung Cancer guidelines.<ref name="NCCN">http://www.nccn.org/professionals/physician_gls/pdf/nscl.pdf</ref> | Shown below is the algorithm on the treatment of the stage IIB non-small cell lung cancer based on the 2014 NCCN Non-Small Cell Lung Cancer guidelines.<ref name="NCCN">http://www.nccn.org/professionals/physician_gls/pdf/nscl.pdf</ref> | ||
{{familytree/start}} | {{familytree/start}} | ||
{{familytree | | | | | | | C02 | | | | | | | | | | C02=<div style="float: left; text-align: left; width: 12em;">'''Perform a pretreatment evaluation'''<br> | {{familytree | | | | | | | C02 | | | | | | | | | | C02=<div style="float: left; text-align: left; width: 12em;">'''Perform a pretreatment evaluation'''<br> | ||
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* Perform a spine [[MRI]] with thoracic inlet searching for superior suculus lesions and infiltration to the [[subclavian vessels]] or [[spine]]</div>}} | * Perform a spine [[MRI]] with thoracic inlet searching for superior suculus lesions and infiltration to the [[subclavian vessels]] or [[spine]]</div>}} | ||
{{familytree | | | | | | | |!| | | | | | | | | | | | |}} | {{familytree | | | | | | | |!| | | | | | | | | | | | |}} | ||
{{familytree | | | | | | | D02 | {{familytree | | | | | | | D02 | | | | | | | | | | D02=What is the location of the [[tumor]]?}} | ||
{{familytree | |,|-|-|-|-|-|^|-|-|-|-|-|-|.| | | | |}} | {{familytree | |,|-|-|-|-|-|^|-|-|-|-|-|-|.| | | | |}} | ||
{{familytree | E03 | | | | | | | | | | | E04 | {{familytree | E03 | | | | | | | | | | | E04 | | | | E03=Superior suculus tumor|E04=<div style="float: left; text-align: left; width: 12em;">Proximal airway <br>OR<br> [[Chest wall]] <br>OR<br> [[Mediastinum]]</div>}} | ||
{{familytree | |!| | | | | | |,|-|-|-|-|-|^|-|-|-|-|. | {{familytree | |!| | | | | | |,|-|-|-|-|-|^|-|-|-|-|.| | | }} | ||
{{familytree | F01 | | | | | F02 | | | | | | | | | F03 | | | {{familytree | F01 | | | | | F02 | | | | | | | | | F03 | | F01=T3 (Invasion to adjacent structures), N0|F02=<div style="float: left; text-align: left;">Preferred option: Surgery + pathological determination of microscopic residual [[tumor]]</div>|F03=<div style="float: left; text-align: left;">Neoadjuvant [[Non small cell lung cancer chemotherapy|chemotherapy]] <br>OR<br>[[Non small cell lung cancer chemotherapy#Chemotherapy plus radiation therapy|chemotherapy + radiation therapy]]</div>}} | ||
{{familytree | |!| | | | | | |!| | | | | | | | | | |! | {{familytree | |!| | | | | | |!| | | | | | | | | | |!| | | |}} | ||
{{familytree | G01 | | | | | G03 | | | | | | | | | G04 | {{familytree | G01 | | | | | G03 | | | | | | | | | G04 | | G01=Neoadjuvant [[Non small cell lung cancer chemotherapy|chemotherapy]]|G02=T4|G03=<div style="float: left; text-align: left;">Are margins from the surgical piece positive or negative for residual [[tumor]]?</div>|G04=<div style="float: left; text-align: left;">Perform surgery + pathological determination of residual tumor</div>}} | ||
{{familytree | |!| | | |,|-|-|^|-|-|.| | | | | | | |!| | | | | | | | | |}} | {{familytree | |!| | | |,|-|-|^|-|-|.| | | | | | | |!| | | | | | | | | |}} | ||
{{familytree | H01 | | H03 | | | | H04 | | | | | | H05 | | | | | | | | H01=Surgery + adjuvant [[Non small cell | {{familytree | H01 | | H03 | | | | H04 | | | | | | H05 | | | | | | | | H01=Surgery + adjuvant [[Non small cell lung cancer chemotherapy|chemotherapy]]|H03=Negative (R0)|H04=<div style="float: left; text-align: left;">Positive: Is the residual [[tumor]] microscopic (R1) or macroscopic (R2)</div>|H05=Are margins from the surgical piece positive or negative for residual [[tumor]]?}} | ||
{{familytree | | | | | |!| | | |,|-|^|-|.| | | |,|-|^|-|.| | | | | |}} | {{familytree | | | | | |!| | | |,|-|^|-|.| | | |,|-|^|-|.| | | | | |}} | ||
{{familytree | | | | | I04 | | I05 | | I06 | | I07 | | I08 | | | | I03=No|I04=Adjuvant [[Non small cell | {{familytree | | | | | I04 | | I05 | | I06 | | I07 | | I08 | | | | I03=No|I04=Adjuvant [[Non small cell lung cancer chemotherapy|chemotherapy]]|I05=Microscopic (R1)|I06=Macroscopic (R2)|I07=Negative (R0)|I08=Positive (R1-2)}} | ||
{{familytree | | | | | | | | | |!| | | |!| | | |!| | | |!| | | | | |}} | {{familytree | | | | | | | | | |!| | | |!| | | |!| | | |!| | | | | |}} | ||
{{familytree | | | | | | | | | J03 | | J04 | | J05 | | J06 | | J01=Initiate neoadjuvant [[Non small cell | {{familytree | | | | | | | | | J03 | | J04 | | J05 | | J06 | | J01=Initiate neoadjuvant [[Non small cell lung cancer chemotherapy#Chemotherpay plus Radiation Therapy|Chemotherapy + radiation therapy]]|J02=Initiate definitive [[Non small cell lung cancer chemotherapy#Chemotherapy plus Radiation Therapy|chemotherapy + radiation therapy]]|J03=[[Tumor]] resection + adjuvant [[Non small cell lung cancer chemotherapy|chemotherapy]]<br>OR<br> [[Non small cell lung cancer chemotherapy#Chemotherapy plus radiation therapy|chemotherapy + radiation therapy]], followed or not by [[Non small cell lung cancer chemotherapy#Chemotherapy plus Radiation Therapy, Followed by Chemotherapy|chemotherapy]]|J04=[[Tumor]] resection + adjuvant [[Non small cell lung cancer chemotherapy|chemotherapy]]<br>OR<br> [[Non small cell lung cancer chemotherapy#Chemotherapy plus Radiation Therapy|chemotherapy + radiation therapy]]|J05=Observation|J06=[[Tumor]] resection}} | ||
{{familytree/end}} | {{familytree/end}} | ||
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[[Category:Pulmonology]] | [[Category:Pulmonology]] | ||
[[Category:Lung cancer]] | [[Category:Lung cancer]] | ||
{{WikiDoc Help Menu}} | {{WikiDoc Help Menu}} | ||
{{WikiDoc Sources}} | {{WikiDoc Sources}} | ||
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[[Category:Surgery]] |
Latest revision as of 19:34, 9 January 2019
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Alonso Alvarado, M.D. [2]Maria Fernanda Villarreal, M.D. [3]
Overview
Therapies for non-small cell lung cancer stage II include surgery, neoadjuvant chemotherapy, adjuvant chemotherapy, and radiation therapy. If the tumor is resectable, the preferred treatment for stage II non small cell lung cancer, includes: surgical resection with lymph node dissection and pathological evaluation. If evidence of lymph node extension of the disease is present adjutant chemotherapy should be administered.
Medical Therapy for Stage II Non-Small Cell Lung Cancer
Stage IIA
Shown below is the algorithm on the treatment of the stage IIA non-small cell lung cancer based on the 2014 NCCN Non-Small Cell Lung Cancer guidelines.[1]
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Perform a pretreatment evaluation
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Does the pathological evaluation showed positive disease in the mediastinal lymph nodes? | |||||||||||||||||||||||||||||||
Yes | No | ||||||||||||||||||||||||||||||
Click here for the stage III treatment | Is the tumor operable? | ||||||||||||||||||||||||||||||
Yes | No | ||||||||||||||||||||||||||||||
Surgical resection + lymph node dissection | Does the patient presents metastasis to ipsilateral peribronchial and/or hiliar nodes and intrapulmonar nodes (N1)? | ||||||||||||||||||||||||||||||
If lymph node extension is detected initiate neoadjuvantchemotherapy + radiation therapy | Yes | No | |||||||||||||||||||||||||||||
chemotherapy + radiation therapy | radiation therapy with stereotactic ablative radiotherapy Adjuvant Chemotherapy should be added for high-risk stages | ||||||||||||||||||||||||||||||
Stage IIB
Shown below is the algorithm on the treatment of the stage IIB non-small cell lung cancer based on the 2014 NCCN Non-Small Cell Lung Cancer guidelines.[1]
Perform a pretreatment evaluation
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What is the location of the tumor? | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Superior suculus tumor | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
T3 (Invasion to adjacent structures), N0 | Preferred option: Surgery + pathological determination of microscopic residual tumor | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Neoadjuvant chemotherapy | Are margins from the surgical piece positive or negative for residual tumor? | Perform surgery + pathological determination of residual tumor | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Surgery + adjuvant chemotherapy | Negative (R0) | Positive: Is the residual tumor microscopic (R1) or macroscopic (R2) | Are margins from the surgical piece positive or negative for residual tumor? | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Adjuvant chemotherapy | Microscopic (R1) | Macroscopic (R2) | Negative (R0) | Positive (R1-2) | |||||||||||||||||||||||||||||||||||||||||||||||||||||||
Tumor resection + adjuvant chemotherapy OR chemotherapy + radiation therapy, followed or not by chemotherapy | Tumor resection + adjuvant chemotherapy OR chemotherapy + radiation therapy | Observation | Tumor resection | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||